Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium.
Department of Laboratory Medicine, National Reference Centre for Enteroviruses, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Eur J Neurol. 2022 Oct;29(10):3117-3123. doi: 10.1111/ene.15478. Epub 2022 Jul 17.
Enterovirus infections pose a serious threat for patients with humoral deficiencies and may be lethal, whilst the efficacy of proposed treatment options such as corticosteroids, intravenous immunoglobulins and fluoxetine remains debated.
Viral clearance was investigated in a patient with rituximab-induced B-cell depletion and chronic echovirus 13 (E13) meningoencephalitis/myofasciitis in response to intravenous immunoglobulins and fluoxetine using sequential semi-quantitative E13 viral load measurements by real-time reverse transcription polymerase chain reaction. Fluoxetine concentrations in plasma and cerebrospinal fluid were determined by liquid chromatography mass spectrometry.
Intravenous immunoglobulins appeared ineffective in this case of E13 infection, whereas virus clearance in cerebrospinal fluid was obtained after 167 days of oral fluoxetine. Since treatment with corticosteroids resulted in a flare of symptoms, rechallenge with viral load measurements was not attempted.
In this report of a patient with rituximab-associated chronic echovirus 13 meningoencephalitis, viral clearance in response to single treatment options is assessed for the first time. Our observations further support the in vivo efficacy of fluoxetine against enteroviral infections. More research is needed to establish its efficacy in different enterovirus strains.
肠道病毒感染对体液免疫缺陷患者构成严重威胁，可能是致命的，而皮质类固醇、静脉注射免疫球蛋白和氟西汀等拟议治疗方案的疗效仍存在争议。
采用实时逆转录聚合酶链反应进行连续半定量 E13 病毒载量测定，研究利妥昔单抗诱导的 B 细胞耗竭和慢性柯萨奇病毒 13（E13）脑膜炎/肌筋膜炎患者对静脉注射免疫球蛋白和氟西汀的病毒清除情况。采用液相色谱-质谱法测定血浆和脑脊液中的氟西汀浓度。
在本例 E13 感染中，静脉注射免疫球蛋白似乎无效，而在口服氟西汀 167 天后，脑脊液中的病毒清除。由于皮质类固醇治疗导致症状加重，因此未尝试重新进行病毒载量测定以进行再挑战。
在利妥昔单抗相关慢性柯萨奇病毒 13 脑膜炎的患者报告中，首次评估了针对单一治疗方案的病毒清除情况。我们的观察结果进一步支持氟西汀对肠道病毒感染的体内疗效。需要进一步研究以确定其在不同肠道病毒株中的疗效。
